Provider Demographics
NPI:1841979754
Name:NEW WAVE EVOLUTION LLC
Entity type:Organization
Organization Name:NEW WAVE EVOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-434-1020
Mailing Address - Street 1:11510 HOMESTEAD RD STE 295&299
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-1237
Mailing Address - Country:US
Mailing Address - Phone:832-434-1020
Mailing Address - Fax:
Practice Address - Street 1:11510 HOMESTEAD RD STE 295&299
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-1237
Practice Address - Country:US
Practice Address - Phone:832-434-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service